Sarcoma arising in a leiomyoma of the uterus

Montague, Andrew C.W.; Swartz, Donald; Woodruff, J. Donald

doi:10.1016/0002-9378(65)90395-9

Cited by 44 publications

(9 citation statements)

References 13 publications

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“…Several reports do not include LMS arising in LM and authors believed uterine LMS occurred de novo 12,13 . However, some articles mention LMS within LM of the uterus and broad ligament 2–9,14–17 . Although, some cases in these studies may not fulfill recent diagnostic criteria of uterine LMS.…”

Section: Discussionmentioning

confidence: 98%

Uterine leiomyosarcoma arising in leiomyoma: Clinicopathological study of four cases and literature review

Yanai

Wani

Notohara

et al. 2010

Pathology International

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In this study we examined four cases of leiomyosarcoma (LMS) arising in leiomyoma (LM). The patients ranged from 40 to 64 years old. Symptoms were unspecific and preoperative diagnosis of LMS had not been made. Size of the tumors ranged from 4 cm to 20.5 cm. All patients were in stage I and no patients developed recurrent disease. Histologically, the LMS component showed moderate to severe cytological atypia and an increased mitotic count in all cases. Tumor cell necrosis in the LMS was seen in three cases. Associated LM component was cellular in one case. The LMS component showed p53 expression in three of four cases and p16 expression was seen in two cases. The LM component lacked p53 expression in all cases and demonstrated p16 expression in two cases, including one case of cellular LM. In all cases, Ki-67-positive cells were less than 5% in the LM component and more than 25-30% in the LMS component. This study reveals that: (i) malignant transformation can occur even in relatively small LM; (ii) patients with LMS with an LM component have a favorable prognosis; and (iii) immunohistochemical examination of p53, p16 and Ki-67 is useful for identification of malignant focus.

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Section: Discussionmentioning

confidence: 98%

Uterine leiomyosarcoma arising in leiomyoma: Clinicopathological study of four cases and literature review

Yanai

Wani

Notohara

et al. 2010

Pathology International

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“…In the present study, the mean age of the 15 uterine sarcoma patients (60.3 years) was demonstrated to be an independent significant risk factor, even using multivariate regression analysis. Various studies have reported on the age of onset of uterine sarcomas, including those stating that it mostly occurs in premenopausal women at approximately 50 years of age (Montague et al 1965 ) and those stating that it rather occurs mostly in postmenopausal women (Aviram et al 2005 ; Parker et al 1994 ); however, in an analysis of 419 uterine sarcoma cases in Norway (Abeler et al 2009 ), Abeler et al stated that the median age was 50.7 years for ESS, 56.5 years for leiomyosarcomas, and 65.7 years for adenosarcomas. We observed 3 premenopausal cases in the sarcoma group, a 38-year old woman with adenosarcoma, a 49-year old woman with leiomyosarcoma and a 51-year old woman with leiomyosarcoma.…”

Section: Discussionmentioning

confidence: 99%

“…Uterine sarcoma is much rarer than uterine myoma, the most common uterine tumor. In the pathological study of 13,000 uterine myoma cases in which surgery was performed, 38 cases (0.29%) were of leiomyosarcoma (Montague et al 1965 ). Although surgery is not indicated for asymptomatic uterine myoma, hysterectomy is often considered for rapidly enlarging uterine tumors because it can be difficult to differentiate a uterine sarcoma from a uterine myoma.…”

Section: Discussionmentioning

confidence: 99%

Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass

et al. 2014

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Preoperative diagnosis of uterine sarcoma is very difficult, and currently, its diagnostic accuracy is not satisfactory. It is therefore important to perform surgery and establish the pathological diagnosis if the clinical findings and various examination findings indicate possible uterine sarcoma. We investigated the accuracy of the combination of various types of predictors of uterine sarcoma and the novel PREoperative Sarcoma Score (PRESS) for avoiding unnecessary surgery while diagnosing uterine sarcoma.We retrospectively analyzed the clinical findings, blood tests, imaging studies (ultrasonography and magnetic resonance imaging [MRI]), and endometrial cytology of 63 suspected uterine sarcoma cases that underwent surgery from 2006 to 2012. These cases were also scored retrospectively using PRESS. We analyzed the number of unnecessary surgeries that could be avoided using PRESS.Of 63 cases, 15 were diagnosed with uterine sarcoma (sarcoma group), and 48 had benign tumors (benign group). Univariate analysis indicated age, serum lactate dehydrogenase (LDH) values, and MRI and endometrial cytology findings as significant predictors of uterine sarcoma in both groups. In contrast, multivariable analysis identified only age, serum LDH value, and endometrial cytology findings as significant predictors. Accordingly, the latter were placed as 2 points, and the remaining MRI finding as 1 point. The accuracy rate of prediction was 84.1%, and the positive and negative predictive values were 63.2% and 93.2% respectively when the PRESS was interpreted as “positive” when it was 3 points or higher.Using multiple predictors for the preoperative diagnosis of uterine sarcoma, our proposed PRESS score is beneficial in the clinical setting while making treatment decisions in suspected uterine sarcoma cases as well as avoiding unnecessary surgery.

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“…Corscaden & Singh [51] reported 32 cases of LMS out of a total of 15 000 leiomyomas diagnosed, representing 0.21%, of which 19 died, reaching a mortality rate of 59% [51]. According to other studies, out of 13 000 operated fibroids, 38 were LMS representing 0.29%, and 18 of them died, reaching a mortality rate of 47% [52]. The preoperative diagnosis of uterine LMS is challenging to establish.…”

Section:  Discussionmentioning

confidence: 99%

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2022

Rom J Morphol Embryol

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Malignant mixed mesodermal sarcomas (myxoid leiomyosarcomas -MLMS) are a rare form of uterine cancer developed from the smooth muscles of the uterus. It usually affects women in the postmenopausal period and has an aggressive character with an unfavorable evolution and prognosis. This paper presents a case where MLMS was postoperatively confirmed with the aid of the histopathological (HP) examination coupled with specific immunolabeling techniques. In addition, we reviewed modern literature to compare our results. Clinically, patients may present with a pelvic tumor, vaginal bleeding, or abdominal pressure. Imagistic investigations, such as pelvic ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT may support the diagnosis. Nevertheless, solely the HP examination establishes it. Macroscopically, MLMS is soft and gelatinous, unlike the conventional rigid and spiral leiomyoma appearance. Furthermore, the infiltrative, irregular tumor margin is characteristic of MLMS. From a microscopic point of view, the following are present: tumor cell necrosis, nuclear pleomorphism, and variable mitotic activity. With classical Hematoxylin-Eosin (HE) staining, myometrium presents a leiomyomatous structure and multiple nodular formations with the aspect of malignant tumor proliferation, most likely mesenchymal. We used multiple special immunolabeling techniques. Thus, we observed the intense reactivity of the cells to the anti-vimentin antibody, which immunolabeled type III intermediate filament (IF) protein expressed in mesenchymal cells, thus demonstrating tumor mesenchymal affiliation. Smooth cell positivity for alpha-smooth muscle actin (α-SMA) demonstrates that the tumor is present in its whole myometrial structure. Tumor cells also underwent mutations involving the p53 tumor suppressor gene demonstrated by the number of tumoral cells in division immunolabeled with anti-Ki67 proliferation antibody. Tumor development was demonstrated by protein activation of cyclin-dependent kinase (CDK) and the presence of c-Kit-bound hematopoietic stem cells, immunolabeled with the anti-cluster of differentiation 117 (anti-CD117) antibodies. The antidesmin antibody demonstrates, along with α-SMA, the involvement of myocytes in the tumoral process. The following microscopic characteristics laid the foundation for the diagnosis of MLMS: irregular myometrial invasion, rare mitosis on high-power fields (HPFs), cell pleomorphism, predominant myxoid component that gave a hypocellular appearance, the matrix rich in proteoglycans and glycosaminoglycans, especially hyaluronic acid.

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Sarcoma arising in a leiomyoma of the uterus

Cited by 44 publications

References 13 publications

Uterine leiomyosarcoma arising in leiomyoma: Clinicopathological study of four cases and literature review

Uterine leiomyosarcoma arising in leiomyoma: Clinicopathological study of four cases and literature review

Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass

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